42% of UK births are c-sections

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Is anyone else surprised at this statistic? I’m sure it was only something like 20% when my now-teen was born.

Although I had noticed how so many of my friends/family members/colleagues having babies recently all seem to have had cesareans.

It looks as though the shift will only continue so potentially c-section will exceed 50% of births and be the more common mode of birth in a few years.

I think it’s really interesting! Will there be drive to try and push numbers down and increase vaginal births again? Or will it eventually become standard for most women to just book in for an elective section as standard and ‘attempting natural’ will be seen as a more unusual choice like home birth is currently.

Opposite for me. I felt more exposed during my vaginal birth and my c-section was a much better experience.

@Psychosislotus Far safer than the other options, especially at the height of Covid.
I'd say an IM is an excellent investment and worth every penny. We used savings as that was a priority over any holiday we could have had.
Anyway, I agree. Sleep time for most.

It’s obviously very individual, but based on what I’ve heard (admittedly only a sample and not the whole population so no one jump down my throat!), vaginal birth is far more exposing and far less dignified - orifices on show, often giving birth on all fours, screaming, defecating, lasts hours etc. and some women just have no interest in putting themselves through that no matter how strong and accomplished we might feel afterwards. Fully supportive and non-judgemental of those who choose this, but I just couldn’t do it.

It's funny though - I didn't scream, or defecate, and no one saw my 'orifices' except for occasional checks by the one midwife until the baby was crowning! I don't think being on all fours is undignified, either. But I agree it usually takes much longer!! My c section was over and done in 2 hours compared to 8 hours.

But most of my mum friends had calm, composed, walking epidural births, water births, or otherwise positive experiences, with only the minority who had vaginal births having negative experiences. There seems to be an assumption about vaginal birth all being some dreadful chaos that really doesn't hold true in most cases, I think, just as people often have mistaken ideas about c sections too.

But then I gave birth in NZ, not the UK, so while our health system is very similar, I imagine there are some differences.

Fair enough! I suppose it goes to show how individual experiences are, both from person to person and even birth to birth, so we can't really make blanket statements about one method of birth vs the other.

Exactly. Which is why choice is so important.

Okay the headline you gave was a bit misleading. Not intentionally I don't think. That data shows that women who had sections resumed sexual activity quicker than women who had tears, and similar complications. Given the majority of women with the general but in that category, that's the one we should be comparing against with a section. The section rates also aren't divided into elective and emergency, and some of the emergency cases will end up with trauma in both locations.

I wasn't trying to make some point, I just thought it was interesting as it validated my personal experience that someone who's had a vaginal birth without a tear is ready to have sex more quickly than someone who's had a c section.

Posters seemed rather disbelieving that someone who'd had a vaginal birth (of any sort!) would be keen to have sex sooner than someone who'd had a c section. But as it turns out, that's fairly normal if you don't tear.

Yes - something I've wholeheartedly agreed with throughout my comments.

It's common for the rare women who have no tearing yes. Not in a typical vaginal birth though.

It's interesting though, that most of your friends have had positive vaginal birth experiences, I guess mine are the opposite. Lots of mine had grade three or four tears. I have friends who made it through the birth unmedicated then had an epidural for surgical repair. Forceps, ventose, 3 day labours ending in emergency sections. Lasting damage, trauma etc. Only one friend had a 'goos' vaginal birth with just a graze and she was still more sore than I was after section.

I think just women would choose vaginal birth, if they were guaranteed a quick manageable labour with no vaginal trauma, but that's basically rolling two sixes.

Well, I feel pretty lucky in that regard, then. I do wonder sometimes how much it has to do with the fact that my mum friends at the time and I were all in our early and mid twenties - an unusually young cohort, while still being fully physically developed.

I have to wonder how much impact having children while older has on how well women handle birth. I know myself how much 'ancient' (less energy more achy, don't bounce back from injuries quite as well) I feel at 38 compared to when I was 20 and full of beans, and I can't imagine putting my body through the ordeal having a child now!!

I have heard this before @searchinghere it's loads isn't it?! About half of that 42% are elective I think?

Hardly surprising though, as vaginal births (VBs) are so much worse than they used to be say - pre 1990s. When I was a child/teen in the 1970s and 1980s, (and for some years before that,) women used to have VBs with very litte complications. I think VBs are more difficult now because babies are bigger. Even so, there has always been difficulties with VBs, and many women died during childbirth many years ago (say 90-100+) but that was because of the lack of medical advancements then. I think the difficulties now are because babies are bigger.

I'm rambling on here but basically, VBs are bloody hard work and high risk, and C-sections are much lower risk in many cases.

Also, women are having children older, and many are not having their first til their early to mid 30s. I hardly know any woman who hasn't had issues with a VB when she was over 30. There are often problems. Many I know now are having elective c-sections, and some are even choosing to go private - for a c-section.)

Indeed as some posters have said, many women - even under 30 - have issues with VBs. They are rarely straightforward. I just know more women who had VBs past 30 who had issues.

What many women don't realise is that you can ASK for a c-section, and say from the beginning that you want one.

You can request a C-section in the UK on the NHS, even without a medical reason. (It is known as a "maternal request" Caesarean). Under NICE guidelines, if you still want a C-section after discussing the risks and benefits, the hospital should support your informed choice and provide one.

Do NOT take no for an answer if you want one. The risks of injuries and harm coming to the mother are higher with a VB than a c-section, and there is more of a risk to the baby too. Women have suffered enough through labour and childbirth for too many years now, with some having life changing injuries after the birth. ASK for a c-section if you feel you want one! THEY CANNOT SAY NO!

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Yes, I was thinking how perhaps some women aren’t aware that they can request a c-section and once that’s widely known, elective c-sections will increase significantly, so that the overall rate will be much higher than 45% (latest figure) in the coming years.

Who is going to do all these additional c-sections? Don’t you think that will be a challenge? Maternity units are reportedly struggling at the moment according to all the headlines.

Generalising here, but I would guess that most women would have a preference for a good vaginal birth over a c-section. The difficulty is that you can't guarantee a good vaginal birth.

Outcomes wise, I think there's probably also evidence that a good vaginal birth is better for the baby than a c-section (but obviously, a bad one carries greater risk).

So I think there's definitely a question of is the NHS doing the right things to give women the best opportunity for a good, safe vaginal birth experience (in addition to allow an informed choice)? Personally I didn't have that trust in the ability of the NHS to do that after my first birth which influenced my decision to opt for a c-section second time round.

I’m not an expert on medical recruitment or the health service in the UK in general, but it will just be a resourcing gap that will have to be solved along with many others, across different areas of healthcare, as demographics and patient care evolve.

It takes a long time to train Obstetricians. From what I understand from medic friends it’s not a popular specialty. So I’d say this further increase in c-sections could place the system under even greater pressure.

I think a “resource gap” is not fully acknowledging the huge structural change this will require- not just medically but also to the midwifery profession. I’m not saying it won’t or shouldn’t happen, but I think you’re underestimating what this change entails and that it’s probably not deliverable given the current NHS cost pressures and capacity constraints.

I expect the sudden, unmanageable increase in c-sections over last decade has led to less attention from medics in the bits of the maternity system that keeps things moving along. The statistic I found of only 5% increase in medics when the workload doubled doesn’t sound sustainable does it?

When this happens in a system, when key people are too busy to do the less urgent tasks, everything slows down or becomes less efficient, people get frustrated/ blamed / stressed. Delays and cancellations become more frequent. Customer experience deteriorates. Staff Culture deteriorates under pressure. That’s why patients will be experiencing poor care from midwives - it’s a consequence - NOT a cause of decline.

So a lot of the recent decline reported by national figures in maternity units could be partly to do with this sudden increase in c-sections. It could be both a cause and consequence of the decline?

This thread is pretty much dominated by individual experiences of women who’ve given birth. But it’s the systemic issues which have the real impact which are probably out of control of most patients and staff.

Airlines are very good at looking at systems and that’s why airline travel is so safe, whereas hospitals and health care from what I’ve read less so…. But they must to take a system level view. I find it worrying that medical staffing has only increased by 5% during a period where consultant led care has become the norm? How can you square that?

No, not necessarily.

The reason for this is that ELCS is less resource intensive than a lot of attempted vaginal births. The ones that take up the most of everything are complex VBs. This is liable to get worse as the trend for birthing women to become older, heavier and more disproportionately first timer continues, because it means the median mother is going to be increasingly less likely to have the demographic factors that make a straightforward and cheap VB more likely.

ELCS agreed way ahead of time also offers the most opportunity for efficiencies in planning and staffing.

Yes for these cases it’s certainly true yes, and population health changes will be a factor in this like you say. But how many women are having clinically unecessary c-sections (I’m NOT saying they should not be able to choose before anyone jumps on me), but what is the cost and impact of facilitating this rise in demand. Are all elective c-sections actually scheduled on time? Or are there delays / cancellations? Do these women waiting for a delayed c-section then become an emergency themselves? The more I think about it, the more complicated it sounds to me and I wonder if the review will be looking into this at all? I just read the recent maternity review interim report and it did mention that the c-section rate had sharply increased and is now above other OECD countries. It could partly be due to maternal age, weight but there must be other factors at play - and I think it makes sense to look at this.

Im not convinced c-sections are cheaper when you factor in all the staff involved including expensive doctors and anaesthetists . Plus recovery, longer stay in hospital. I was told you’re more likely to have complications with future pregnancies. We need to look at the benefits and costs at a system level.

Exactly this. Women NEED to know they can have a c-section. Just because women know this, that doesn't necessarily mean every woman is going to have one! But they need to know THEY CAN ASK FOR ONE.

Also, as you say, lots of resources and time is taken up with VBs that go wrong, and many do, especially when women are past their mid 30s. So they can divert the money and resources that VBs use (and many do not go smoothly!) for routine/planned c-sections.

I had an emergency c-section after over 40 hours in labour, (and problems with the birth that I won't bore you with,) and I was advised I should have one for the second baby too. I did of course.

I think every woman should have the choice, and they need to know they can choose to have a c-section. As you say, the money and time and resources saved from difficult and traumatic VBs would help fund the extra c-sections.

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All this needs to go into the mix yes, but it’s only part of the picture. I think we all want women to be supported, have choice, staff to have the time to deliver the care needed at the right time. But we all know that’s not been happening despite a decade of focused improvement work (the maternity review said over 700 improvements required in the last decade - that sounds like a lot to me) so we need to ask why we have not seen improvement despite all the changes?

There are lots of ways in which healthcare needs to adapt to accommodate changing demographics and patient lifestyles. We are highly unlikely to reverse the trend in increased maternal age and low birth rate anytime soon. There’s not suddenly going to be a shift where most mothers giving birth will be 18-22, have no underlying health issues, and will go on to have 5 more babies. It’s just not going to happen. Like many other areas of healthcare, the health service will need to adapt. I’m not saying it’s straightforward but it is something that will need to happen.

Thing is, if these are questions for you rather than answers, it's premature of you to say an increase in ELCS rates is 'probably not deliverable'. I have no problem with wanting to look into the issue, but that does require being open to all possibilities. Worth pointing out there are lots of countries with much higher CS rates than us too.

A few years back, NICE found that ELCS is barely more expensive when all downstream costs are considered. However, some of the data they were using went back as far as the 90s, where the birthing population were demographically more likely to have straightforward VBs, which isn't the case now. Also quite often, in things like NICE analysis they do throw in the ELCS and EMCS stats in together (they did in the most recent ELCS vs planned birth review) just from necessity, as so much of the research is bad at separating the two out.

The starting point needs to be an understanding that ELCS is not necessarily a longer stay in hospital. Because a proportion of women attempting VB will go on to have EMCS or instrumentals. Those require obstetricians and usually theatre time, and they require them after the usual midwifery care in labour too. Or sometimes more than the usual level, as some higher risk women who need more intensive monitoring may still attempt a VB. Some of these women will have been induced rather than having an ELCS too, which again adds to resource costs.

In terms of scheduling, I don't know that ELCS rates are high enough yet for any efficiencies to be in play, but they get scheduled during the day rather than say at 4am. If you're going to perform a section on a woman, from a resource perspective you want to do it during the day with plenty of time to do the rotas rather than in the middle of Sunday night on a bank holiday weekend.

it's actually still surprisingly difficult to plan for elective section lists because pregnancy is quite unpredictable - women occasionally go into labour before their date/ develop complications that mean dates need to change/ change their mind on the day because their breech babies have turned cephalic etc etc. And it's becoming increasingly common for women to point blank refuse to accept being asked to change their section to a different date even when we're trying to juggle pretty fluid operating lists and a combo of high risk patients and more straightforward stuff in a system with finite resources. Where I work despite having several elective section lists a week, staffed completely separately to labour ward activity there isn't enough capacity for all the patients that want/need them so there's a lot of juggling that goes on to try and squeeze people in.

presumably number 2. means 'elective section without complications'... even with an anticipated straightforward elective section for maternal request reasons things sometimes don't go to plan.